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Vidya
Venkataramanan
Author
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking.
The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically
analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners.
My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
Summer 2017
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of
Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in
2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental
health and development challenge. Community-led total sanitation (CLTS) has become the
predominant behavior change approach to improve sanitation in rural communities in lower
income countries. It is acknowledged as flexible and context-specific, but a systematic
analysis of its implementation was lacking. The purpose of this dissertation was to study
the context and process of CLTS implementation in various settings to identify factors
that influence implementation and thereby, outcomes of the intervention. I conducted a
systematic literature review of the available evidence on CLTS to document adaptations,
effectiveness on sanitation and health outcomes, and quality of evidence. I found that the
diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness.
I also found that, although CLTS adaptations had been widely documented by practitioners,
no study had characterized adaptations to understand how best to structure programs to
improve their effectiveness in various settings. Therefore, I analyzed adaptations through
qualitative case studies of CLTS implementation in seven countries. Data collection
included interviews with 293 respondents, and 34 community visits. Rather than being a
“community-led” approach, I found that CLTS can be categorized into three broad
implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of
CLTS. I applied an implementation research framework to these case studies to
systematically analyze context and process factors that influence CLTS implementation.
This framework serves as both a hypothesis generating tool for researchers and a
diagnostic tool for practitioners. My work suggests that an honest exploration and
understanding of CLTS implementation is vital to identify improvements, to understand the
potential of the approach to achieve desired outcomes, and to recognize ways in which it
can be implemented to improve rural sanitation in different contexts and settings. By
building a stronger evidence base of mixed methods, and offering concrete tools and
recommendations for practitioners and policymakers, the aim is to bridge the gaps between
academic implementation theory, ambitious policymaking, and dynamic CLTS practice to
improve sanitation programs.
Summer 2017
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative,
sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Environmental Sciences and
Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
Summer 2017
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017-08
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change; case study; implementation; qualitative; sanitation; systematic review
eng
Doctor of Philosophy
Dissertation
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change, case study, implementation, qualitative, sanitation, systematic review
eng
Doctor of Philosophy
Dissertation
Environmental Sciences and Engineering
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Vidya
Venkataramanan
Creator
Department of Environmental Sciences and Engineering
Gillings School of Global Public Health
One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation
An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs.
2017
Public health
Public policy
Environmental studies
behavior change; case study; implementation; qualitative; sanitation; systematic review
eng
Doctor of Philosophy
Dissertation
Jamie
Bartram
Thesis advisor
Pete
Kolsky
Thesis advisor
Margaret
Bentley
Thesis advisor
Jacqueline
MacDonald Gibson
Thesis advisor
Clarissa
Brocklehurst
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Venkataramanan_unc_0153D_17289.pdf
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2017-07-20T19:40:32Z
2019-08-15T00:00:00
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